Organization
LAKESHORE MEDICAL CLINIC LTD
Active
Other names
LMC Bucyrus Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MASOOD WASIULLAH MD (PRESIDENT)
(414) 744-6589
Entity
Organization
Contact information
Practice address
1100 MILWAUKEE AVE, SOUTH MILWAUKEE, WI 53172-2013
(414) 764-4003
Mailing address
100 15TH AVE, SOUTH MILWAUKEE, WI 53172-1160
(414) 764-3241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/19/2009
Last updated
04/28/2010
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